| NPI | 1104203074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX 46268) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY P01935) |
| 207W00000X Ophthalmology (Licence: KY FT548) | |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2019-01-30 |